SLIDING SCALE INSULIN ASPART PROTOCOL PLAN

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1 Weight Allergies Patient Care Accucheck Per Sliding Scale Insulin Frequency AC & HS AC & HS 3 days TID BID q12h q6h q6h 24 hr q4h q2h Sliding Scale Insulin Protocol Follow SSI Reference Text Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. insulin aspart (Low Dose Insulin Aspart Sliding Scale) 0 10 units, subcut, inj, AC & nightly, PRN glucose levels see parameters 0 10 units, subcut, inj, q6h, PRN glucose levels see parameters 0 10 units, subcut, inj, q4h, PRN glucose levels see parameters Continued on next page... Page: 1 Sliding Scale Insulin Aspart Protocol Plan Version: 1 Effective on: 10/30/12

2 0 10 units, subcut, inj, q2h, PRN glucose levels see parameters 0 10 units, subcut, inj, TID, PRN glucose levels see parameters 0 10 units, subcut, inj, BID, PRN glucose levels see parameters Page: 2 Sliding Scale Insulin Aspart Protocol Plan Version: 1 Effective on: 10/30/12

3 insulin aspart (Moderate Dose Insulin Aspart Sliding Scale) 0 12 units, subcut, inj, AC & nightly, PRN glucose levels see parameters 0 12 units, subcut, inj, q6h, PRN glucose levels see parameters 0 12 units, subcut, inj, q4h, PRN glucose levels see parameters 0 12 units, subcut, inj, q2h, PRN glucose levels see parameters Page: 3 Sliding Scale Insulin Aspart Protocol Plan Version: 1 Effective on: 10/30/12

4 0 12 units, subcut, inj, TID, PRN glucose levels see parameters 0 12 units, subcut, inj, BID, PRN glucose levels see parameters insulin aspart (High Dose Insulin Aspart Sliding Scale) 0 14 units, subcut, inj, AC & nightly, PRN glucose levels see parameters 0 14 units, subcut, inj, q6h, PRN glucose levels see parameters Page: 4 Sliding Scale Insulin Aspart Protocol Plan Version: 1 Effective on: 10/30/12

5 0 14 units, subcut, inj, q4h, PRN glucose levels see parameters 0 14 units, subcut, inj, q2h, PRN glucose levels see parameters 0 14 units, subcut, inj, TID, PRN glucose levels see parameters 0 14 units, subcut, inj, BID, PRN glucose levels see parameters insulin aspart (Blank Insulin Aspart Sliding Scale) Page: 5 Sliding Scale Insulin Aspart Protocol Plan Version: 1 Effective on: 10/30/12

6 See Comments, subcut, inj, PRN glucose levels see parameters Blood glucose < ; Initiate hypoglycemic protocol and Call physician; units; units subq; units subq; units subq; units subq; units subq; units subq; >400 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG <, then resume normal accucheck and sliding scale routine. Call physician HYPOglycemia Protocol HYPOglycemia Protocol If BS < 70 mg/dl, and patient SYMPTOMATIC, give 6 oz. of juice PO (if applicable) and/or follow HYPOglycemia Protocol meds. glucose (D50) 25 g, IVP, syringe, as needed, PRN glucose levels see parameters Patient unable to swallow / NPO WITH IV access. Dextrose 50% 50 ml IV. Recheck BG in minutes. Repeat treatment until blood glucose > 100 mg/dl. If not NPO provide additional snack once able to swallow. glucose 15 g, PO, gel, as needed, PRN glucose levels see parameters glucagon 1 mg, IM, inj, as needed, PRN glucose levels see parameters Patient UNABLE to swallow / NPO WITHOUT IV access. Administer Glucagon 1 mg IM or SubQ. Contact physician for further orders. Establish IV access with saline lock. Recheck BG every 15 to 20 minutes. Use aspiration precautions as glucagon may cause nausea and vomiting. Page: 6 Sliding Scale Insulin Aspart Protocol Plan Version: 1 Effective on: 10/30/12

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